Impact of spirometry on GPs' diagnostic differentiation and decision-making
Impact of spirometry on GPs' diagnostic differentiation and decision-making
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DOI：
10.1016/j.rmed.2004.04.004
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发表时间：
2004-11-01
影响因子：
4.3
通讯作者：
Bottema, B
中科院分区：
文献类型：
--
作者：
Chavannes, N;Schermer, T;Bottema, B
背景：肺活量测定法越来越多地在全科医生中实施，而全科医生（gp）解释流量-体积曲线（F-V曲线）的能力受到质疑。此外，肺活量测定在全科医生决策过程中的作用几乎没有研究。目的：比较训练有素的全科医生在肺量计诊断方面的成就与专家共识小组(1)，并评估肺量计对全科医生决策的影响(2)。方法：由39名gp和专家小组对12例宽范围的F-V曲线进行解释。采用多级分析计算诊断试验特征，并采用诊断优势比（DOR）进行总结。决策指标的差异用比值比和95%置信区间表示。结果：正常F-V曲线（DOR 65.0）和阻塞性F-V曲线（DOR 48.9）诊断较好，白色罕见和混合病理模式得分较低（DOR 3.8）。在错误测试操作的识别上获得中等分数（DOR 24.4）。肺活量测定法在减少替代诊断数量方面影响了全科医生的决策（OR为0.266[0.200,0.353]），但也显著增加了转诊率（OR为7.26[4.71,11.2]）和诊断性强的松龙疗程的使用（OR为4.55[3.12,6.64]）。结论：训练有素的全科医生能够区分正常和阻塞性疾病模式，而提示罕见和混合病理的F-V曲线经常被遗漏。肺活量测定似乎影响全科医生的决策过程；这是否代表一个初始或更持久的影响仍有待于评估在日常初级保健实践的研究。(C) 2004 Elsevier Ltd.版权所有。
Background: Spirometry is increasingly implemented in general practice, while the ability of general practitioners (GPs) to interpret flow-volume curves (F-V curves) has been questioned. Furthermore, the role of spirometry in the GPs decision-making process has barely been studied.Aim: To compare the achievements of trained GPs in spirometric diagnosis with an expert consensus panel (1) and to assess the influence of spirometry on the GPs decision-making (2).Method: Twelve cases including a wide range of F-V curves were interpreted by 39 GPs as well as the expert panel. Diagnostic test characteristics were calculated using multi-level analysis and summarised by diagnostic odds ratios (DOR). Differences in decision-making indicators were expressed as odds ratios and 95% confidence intervals.Results: Normal F-V curves (DOR 65.0) and obstructive F-V curves (DOR 48.9) were reasonably well diagnosed, white rare and mixed pathological patterns achieved considerably lower scores (DOR 3.8). Intermediate scores were obtained in the recognition of incorrect test manoeuvres (DOR 24.4). Spirometry influenced the GPs decision-making in reducing the number of alternative diagnoses (OR 0.266 [0.200, 0.353]), but also increased referral rates (7.26 [4.71, 11.2]) and the use of diagnostic prednisolone courses (4.55 [3.12, 6.64]) substantially.Conclusion: Trained GPs were able to differentiate between normal and obstructive disease patterns, while F-V curves suggestive of rare and mixed pathology were often missed. Spirometry seems to influence the decision-making process of the GP; whether this represents an initial or a more sustained effect remains to be evaluated in studies of daily primary care practice. (C) 2004 Elsevier Ltd. All rights reserved.